Risk Factors of Bordley et al for Identifying Patients with Acute Upper Gastrointestinal Hemorrhage Who Are at Low Risk

 

Poor outcome:

(1) death

(2) urgent surgery

(3) major recurrent hemorrhage

(4) significant complication caused by the upper GI bleeding or its therapy

(5) prolonged hospitalization

(6) transfer to the ICU

(7) prolonged change in the management of a chronic problem present before the bleed

 

Parameters associated with low risk for a poor outcome:

(1) age < 75 years

(2) no unstable comorbid illness

(3) no ascites found on initial physical examination

(4) prothrombin time "normal" (either within 2 seconds of normal control or if patient taking warfarin)

(5) systolic blood pressure >= 100 mm Hg within an hour after presentation

(6) nasogastric aspirate free of fresh blood within an hour after presentation

Parameter	Finding	Points
age	< 75 years	1
	>= 75 years	0
comorbid condition	none	1
	stable	1
	unstable	0
ascites on initial exam	none	1
	present	0
prothrombin time	within 2 seconds of control	1
	patient receiving coumadin	1
	> normal control + 2 seconds	0
systolic blood pressure at 1 hour	>= 100 mm Hg	1
	< 100 mm Hg	0
nasogastric aspirate at 1 hour	free of fresh blood	1
	positive for fresh blood	0

 

risk score =

= SUM(points for all 6 factors)

 

Additional risk factors initially identified but eliminated on discriminant analysis:

(1) no history of hepatic disease

(2) normal mental status on presentation

(3) initial systolic blood pressure >= 100 mm Hg

(4) no liver enlargement found on initial physical examination

(5) no jaundice

(6) no cachexia

(7) hematocrit value >= 40 percent

 

Interpretation:

• minimum score: 0

• maximum score: 6

• If all 6 factors are present, then the patient is considered to be at low risk

 

Performance:

• Sensitivity 63%, specificity 94%.